Encouraging Excellence in the Central Sterile Department

By Michael Matthews, CRCST, CIS, CHL

Someone recently asked me, “As a central sterile (CS) manager, what keeps you up at night – what is it that scares you the most relating to your department?”  As I thought about all the possible things that could go wrong, from the mundane such as an autoclave breaking down to the exotic scenario such as a sprinkler system failure forcing me to reprocess all instruments, one thing jumped out in my mind and truly made me shudder. “Losing my staff,” I answered, “in fact, most CS managers would say the same.” 

High turnover rates have long been the norm for sterile processing. Almost every manager can think of at least one employee whose departure still sticks in their mind as a painful loss. But beyond the stress placed on CS managers to hire and train new techs is the reality that long term retention of high performing CS staff must become a top priority for hospitals for patient’s welfare, surgeon satisfaction, and the hospital’s financial wellbeing.

SSIs
Everyone in healthcare ought to know the statistics for surgical site infections, but they bear repeating:
• Surgical site infections account for 31 percent of all healthcare-associated infections (HAIs)
• That’s approximately 157,000 patients
• 3 percent of those patients, approximately 4,700, die with 3,500 of those deaths being directly attributable to the SSI.
• Cost range of SSIs are between $10,443 and $25,546 for each occurrence, or more than $4 billion total, annually. 

While great strides have been made in infection prevention practices, one of the most important aspects of infection prevention, namely the retention of high performing CS staff, has been largely ignored by too many hospitals.

Central Sterile Technicians Affect Patient Welfare
CS techs do not easily fit into a normal healthcare category. Techs have no patient contact and yet everything they do has a direct effect on patient welfare. The unspoken attitude toward sterilization is that a good autoclave can cover a multitude of tech mistakes. Therefore, CS staff is often viewed as dishwashing 2.0. Hospital’s must come to the realization that single poorly trained CS tech can adversely affect more patients in a single day than a bad surgeon. In fact, ECRI’s annual list of the top 10 patient safety concerns listed inadequately reprocessed surgical equipment as their number eight concern, which is the sixth year in a row that reprocessing has been in their top 10. Hospitals can no longer act as though CS technicians do not have a dramatic effect on patient care and safety simply because they are not physically present in the surgical suite with the patient.

Central Sterile Technicians Affect Surgeon Satisfaction
Surgeons often have a reputation for angry outbursts during surgical procedures, but what is often overlooked is that immense pressure that is placed on these individuals.  If things turn out poorly for a patient, regardless of who is actually at fault, the surgeon knows that he or she is who will be held responsible by the patient and their loved ones. Surgeons are often viewed as “demanding” because they want the best outcome for their patient and that requires as few surprises during the surgical procedure as possible. 

“Our sterile processing focuses on performance excellence so our surgeons can focus on their patient,” states Nora Osborne, director of surgical services at Conway Regional Hospital in Conway, Ark., summarizing the connection between sterile processing and surgeon performance.  When an instrument fails mid-surgery a number of adverse events are possible, including increased time under anesthesia, increased risk of infection, longer recovery periods, and even additional surgery. These risks are in addition to the aforementioned risks of SSI’s which are costly for surgeons both in time and money. Additionally, one can imagine few things more frustrating and emotionally draining for a surgeon than for a procedure to go well, only to have the patient continue to suffer due to a preventable event. 

Central Sterile Technicians Affect the Hospital’s Bottom Line
The first objection most hospitals would raise to creating a career ladder for CS technicians is it would cost too much money.  Yes, it costs money to create a career ladder for CS staff, but hospitals must realize that they are already paying that money and more through cost of training new CS employees. Hospital administration must begin to look at long term retention of CS technicians as an investment. A 2010 article in the AORN Journal demonstrated that the average cost for training a new CS staff member was approximately $41,000 in 2008, which was an increase of more than 100 percent versus 1998, whereas retaining a skilled employee through a career ladder that offers an increase of pay of $5 to $10 per hour would cost less than half that amount. Additionally, it should be obvious that newer employees are more prone to making mistakes. Mistakes in healthcare cost money, either through damaged, destroyed, or lost instrumentation or through inadequate cleaning and sterilization leading to infections and all associated costs.  A well-trained and experienced CS tech is well worth any money required to keep them through cost prevention and should be viewed as such by hospital decision-makers.

Where Do We Go From Here
In 2011, the representatives from AAMI and the FDA held a summit on the topic of how to improve the nationwide condition of sterile processing.  During this summit, 10 clarion themes were identified for national focus. These themes covered a wide range of topics, from better defining terms used in the industry to more clearly written instructions for use from the manufacturers. Clarion theme No. 6 emphasized the need for training, educating, certifying, rewarding, and retaining qualified central sterile staff. The responsibility for this challenge was laid squarely on the individual hospitals. Four years later many CS managers continue to be terrified of losing their high performers due to inadequate incentivizing of long term retention. This is to say nothing of the fact that attracting top level talent in the first place can be an insurmountable challenge due to the fact that low pay makes CS technician an untenable career option, particularly for young adults who have 25-plus years left in the workforce. However, higher pay must been seen as only part of a total overhaul of how hospitals view CS personnel. A full career ladder should be established that incentivizes increased competencies, education, and performance with the goal of retaining high-quality CS personnel.

Michael Matthews, CRCST, CIS, CHL, is manager of central sterile processing at Conway Regional Health System in Conway, Ark.
 

References:

Centers for Disease Control and Prevention (CDC). Surgical Site Infection (SSI) Event. January 2015. Retrieved from: http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf
 
ECRI Institute. Top 10 Patient Safety Concerns for Healthcare Organization: 2015. April 2015.
 
Chobin N. The Real Costs of Surgical Instrument Training in Sterile Processing Revisited. AORN J, Vol 92:2 August 2010, 185-193.
 
Association for the Advancement of Medical Instrumentation (AAMI) and the Food and Drug Administration (FDA). Medical Device Reprocessing Summit 2011. Available online at: www.aami.org/productspublications/summitreports.aspx